Osteopathy

Definition

Osteopathy is a "whole person" philosophy of medicine, where doctors of osteopathic medicine (DOs) endorse an approach that treats the entire person, rather than a specific complaint. Attention is given to prevention, wellness, and helping the body to heal itself. Because the body is viewed as a single organism or unit, special focus is given to understanding body mechanics and the interrelationship of the body's organs and systems. A particular emphasis is placed on the musculoskeletal system. Dos may utilize physical manipulation of muscles and bones in conjunction with, or as an alternative to, conventional treatments, drug therapies, and surgery to provide complete health care.

Origins

Dr. Andrew Still developed the osteopathic approach to medicine. Still, whose father was a Methodist minister and physician, was himself a medical doctor who served as a Union surgeon during the Civil War. After the war, personal tragedy struck the Still household when three of his children died from spinal meningitis. This event angered and disillusioned him. He became dissatisfied with the state of medical knowledge and treatments available at that time. Consequently, he began an intense study of the human body to find underlying causes and cures for ailments.

Still gave great attention to anatomy. He recognized the importance of the musculoskeletal system, the body's ability for self-healing, and focused on prevention and the concept of "wellness." In an era when drug treatment was frequently dangerous and overused, and surgery often fatal, Still was able to develop alternative treatments. For example, by manipulating the ribs and spine, Still provided treatments for pneumonia. He gave attention to the lymphatic system (which filters foreign matter and removes excess fluids, proteins, and waste products from the tissues and transports them to the blood to be circulated and eliminated) and manipulating the fascia (connective tissue that is tough, but thin and elastic; it forms an uninterrupted three-dimensional network from head to foot, sheathing every muscle, bone, nerve, gland, organ, and blood vessel), allowing him to address a range of other ailments.

Still's sons learned his philosophies and techniques, but demand overwhelmed their ability to supply care. In 1892, Still founded the first college of osteopathic medicine, the American School of Osteopathy, in Kirksville, Missouri. When he died in 1917, there were more than 5,000 practicing osteopaths in the United States. Today, osteopaths are the fastest growing segment of the total population of physicians and surgeons in the United States. In 2002, there were more than 49,000 doctors of osteopathy. Osteopathy has spread outside of the United States and is now practiced in countries throughout the world.

Benefits

The osteopathic focus on prevention and wellness may help individuals to avoid illness by teaching healthy behaviors and encouraging health-promoting lifestyle changes. In addition to conventional treatments, drugs, and surgeries, DOs may offer manipulative therapies not available from their allopathic counterparts MDs). Many people seek care from an osteopath for back or neck pains, joint pains, or injuries. However, DOs may use manipulative therapies to treat a variety of ailments and conditions including arthritis, allergies, asthma, dizziness, carpal tunnel syndrome, menstrual pain, migraine headaches, sciatica, sinusitis, tinnitus (ringing in the ears), and problems in the jaw joints. Manipulative therapies may be incorporated into the treatment plan to speed recovery from various conditions, such as heart attack or disc surgery, and to address pediatric concerns, such as otitis media (ear infection) and birth traumas. Various manipulative therapies may also be appropriate in alleviating discomforts associated with pregnancy, for example, back pain or digestive problems. Some osteopaths even feel that regular osteopathic treatments may help minimize the effects of aging on the spine and joints. Also, as noted by the American Osteopathic Association (AOA), the field of sports medicine has found particular benefit in osteopathic practitioners because of their emphasis on "the musculoskeletal system, manipulation, diet, exercise, and fitness. Many professional sports team physicians, Olympic physicians, and personal sports medicine physicians are DOs."

Description

Osteopathic medicine considers the human body to be a complex unit of interrelated parts, a unified organism. Organs and systems do not function independently and should not be treated as such. A disturbance in one part of the body affects the entire body. Illness is also impacted by many variables, such as emotions, stress, lifestyle, and environment. Therefore, illness must be addressed by taking a whole person approach to treatment. Because the body is seen as self-regulating and self-healing, the osteopath gives special attention to illness prevention and helping the body maintain or re-establish wellness.

The nervous and circulatory systems play crucial roles in maintaining the functioning of the body's organs and systems; negative body-wide effects may occur when these two major systems are not functioning optimally. Relieving blocked blood flow or nerve impulses will help the body to heal itself by promoting blood flow through affected tissues. The blood supply will be better able to deliver vital nutrients and boost the immune system, the nerve supply to the area will be improved, and systemic balance can be restored.

The musculoskeletal system is key in this effort to achieve and maintain systemic balance and health. The musculoskeletal system is comprised of the bones, tendons, muscles, tissues, nerves, and spinal column. As the body's largest system, it encompasses over 60% of body mass and can suffer mechanical disorders or amplify illness processes anywhere in the body. Therefore, structural evaluation and attention to the musculoskeletal system is central to osteopathy.

In addition to conventional care such as drug therapies and surgery, osteopaths may use a variety of manipulative procedures to help the body systems function at peak levels. These techniques are commonly referred to as Osteopathic Manipulative Treatment (OMT). OMT is a form of noninvasive, "hands-on" care used for prevention, diagnosis, and treatment to reduce pain and restore motion, as well as help the body heal itself. OMT may be used to facilitate the movement of body fluids and normal tissue functioning, and release painful joints or dysfunctional areas. These therapies take different forms depending on patient needs.

In addition to easing the pain of physical disorders, OMT appears to be helpful in some psychiatric conditions as well. A recent study performed at the College of Osteopathic Medicine in Downers Grove, IL, found that OMT as an adjunct to psychotherapy alleviated the symptoms of depression in women, as measured by the Zung Depression Scale, a standard diagnostic instrument.

ANDREW TAYLOR STILL 1828–1917

Andrew Taylor Still, the father of osteopathy, was born on August 6, 1828, in Virginia to Abram and Martha Still. Growing up on the frontier lands of Tennessee and Missouri provided the impetus for his first studies of the musculoskeletal system. Skinning squirrels and deer, Still became familiar with the relationship between bones, muscles, nerves, and veins long before he picked up an anatomy book. He later studied medicine under his doctor-preacher father and served as a Union surgeon during the Civil War.

Following the war, his distrust of traditional medicine grew when three of his children died of cerebrospinal meningitis. Still decided that the medications of his day were useless and that there had to be another way.

Still studied the attributes of good health so he could understand disease. He saw the body as a complex machine that, when working properly, stayed free of disease. He turned to a drugless, manipulative therapy believing disease was caused by a failure of the human machinery to carry the fluids necessary to maintain health. He called his holistic approach osteopathy for the Greek words osteon, meaning bone, and pathos, to suffer.

Still gained a following working as an itinerant healer, and in October 1892, he opened the American School of Osteopathy in Kirksville, Missouri. Still welcomed women even as other medical schools denied them access.

As of 2000, there were 16 osteopathic medicine colleges in the United States and 35,000 practicing doctors of osteopathy. The Kirksville College of Osteopathic Medicine remains open.

Manipulative procedures may be categorized and discussed in a variety of ways. According to the American Association of Colleges of Osteopathic Medicine, the following groupings encompass some of the most commonly used procedures. Descriptions are compiled from the American Academy of Osteopathy, Leon Chaitow, N.D., DO, and others.

Articulatory techniques. Procedures that move joints through their range of motion (articulating the joints) may be used to restore normal functioning.

Counterstrain. This type of therapy is used to alleviate trigger points localized areas of hyperirritability in the muscles). The procedure involves first finding a body position that relieves the patient's pain. Through a process in which the patient and practitioner repeatedly use coordinated techniques of pushing (or compression), relaxing, and changing position, the trigger point is eased.

Cranial treatment. Cranial treatments focus on the craniosacral system which consists of the brain, spinal cord, cerebrospinal fluid, dura (the membrane covering the brain and spinal cord), cranial bones, and the sacrum (triangular bone comprised of five fused vertebrae, and forming posterior section of the pelvis). Craniosacral release is a gentle technique that focuses on normalizing imbalances in the natural rhythms of this system. A light touch is used to detect and release restrictions in the system and encourage the body's own healing processes. Craniosacral therapies arose from the work of Dr. William Sutherland, a DO who developed and explored the concept that the bones of the skull allowed movement and could be manipulated to improve the system's rhythmic movements. Some DOs choose to specialize in cranial osteopathy. Craniosacral therapy is also practiced by a wide variety of health care professionals. As listed by the Upledger Institute, these practitioners include MDs, chiropractors, doctors of Oriental medicine, naturopaths, nurses, psychiatric specialists, psychologists, dentists, physical therapists, occupational therapists, acupuncturists, massage therapists, and other professional bodyworkers.

Lymphatic techniques. These techniques focus on improving lymphatic circulation, improving the ability of the lymphatic system to do its job of waste removal.

Soft tissue techniques. Applied to tissue other than bone, these techniques use varying pressure and may stretch, roll, or knead, resulting in the relaxation or release of tissues.

Thrust techniques. A quick, sharp thrust (which is often described as high velocity/low amplitude) to the area requiring treatment is used to force a correction, restoring normal joint function and movement. This is similar to chiropractic adjustment.

Precautions

DOs use the full range of conventional diagnostic techniques, drug therapies, treatments, and surgical interventions available to MDs. If deemed appropriate by the DO, OMT may be employed in addition to these conventional diagnoses, and treatments or may serve as an alternative to drug therapies. During the course of treatment, manipulative therapies may be interrupted or stopped if complications occur—for example, a rise in blood pressure. In some situations, the osteopath may determine that no further benefit will be gained from continuing manipulative treatment. Manipulation should not be applied in several medical conditions. As listed by Chris Belshaw, these conditions are mainly "acute infections; fractures; bone disease; cancer; gross structural deformities; such severe general medical conditions as gross high blood pressure or heart attack; vascular disease, for example, thrombosis; neurological conditions with nerve damage; spinal cord damage; and severe prolapse of an intervertebral disc." Additionally, as in any area of medicine, there is the possibility of mistaken diagnosis. Patients should always discuss all medical conditions, treatments, questions, and concerns with their physicians.

Side effects

Some patients, as noted by Belshaw, may experience mild headaches following neck treatments or discomfort after back manipulation. Some flushing and bruising may appear on those with sensitive skin. These reactions may last for several hours. Such symptoms may recur as treatment continues. Symptoms may return if treatment is stopped too soon.

Research & general acceptance

Research has shown the benefits of osteopathic care in a range of ailments and through improved recovery times. In addition to many of the conditions discussed above, the American Osteopathic Healthcare Association reports ongoing research on patient recovery times, length of hospital stays, chronic pain, chlamydia infection in women, reduction of deep vein thrombosis, and fall prevention for the elderly. Osteopathic colleges have increased their attention to biomedical research opportunities for students and those who desire to pursue research careers. The AOA Board of Research encourages and supports development of scientific research in the osteopathic medical profession. The AOA has also conducted several campaigns to educate the public on osteopathy. In 2000, the AOA started a Women's Health Initiative, a three-year campaign to promote women's healthcare among osteopathic physicians and the public.

Training & certification

Training and certification for DOs exceed those of chiropractors and physical therapists, two groups to which their manipulative techniques are sometimes compared. Chiropractic training focuses on spinal manipulation only. Chiropractors typically have fewer years and types of required postgraduate training, and are more limited legally in their practice. DOs also have training and licensing well beyond that of physical therapists.

Osteopathic physicians, like their allopathic physician counterparts, are complete physicians. This means they are trained and licensed to prescribe medication and perform surgery, and qualified to render complete healthcare. DOs are fully licensed in all 50 states and the District of Columbia, to serve in the military medical corps, Veterans Administration, and Public Health Service, and are recognized by the American Medical Association as physicians. They hold the same practice rights as MDs, have passed the same or similar state licensing examinations, and practice in fully accredited hospitals. DOs can practice in all branches of medicine and surgery, and can specialize in any area, but the majority are primary care physicians.

As of spring 2002, the AOA lists 20 AOA-accredited colleges of osteopathic medicine. Training for DOs and MDs parallel in many ways. Osteopathic colleges, like medical schools, offer a basic, comprehensive four-year medical education. Added to this curriculum are the osteopathic philosophies and a holistic care emphasis on prevention and community care. In addition to stressing the inter-relatedness of body organs and systems, students of osteopathy are taught to consider the whole person, including lifestyle, emotional factors, and environmental factors. Training also focuses on the musculoskeletal system and manual medicine. Manipulative therapies are taught for prevention, diagnosis, and treatment, and the osteopathic principle of helping the body toward good health.

After graduation from the four-year curriculum, DOs complete a one-year rotating internship, followed by several years in a residency program, if a specialty is desired. The areas covered during the internship period ensure that each DO is first trained as a primary care physician. Over half of all DOs are primary care physicians. Conversely, MDs are more likely to be specialists.

After the formal education process, the AOA requires members to earn continuing medical education (CME) credits every three years. To further enhance postgraduate medical education, the AOA has implemented the concept of Osteopathic Postdoctoral Training Institutions (OPTIs), which reflect the osteopathic emphasis on community care. These OPTIs are community-based consortia that include at least one hospital and college of osteopathic medicine. The intention of these is to promote institutional collaboration and enhance training opportunities that reflect the settings in which many osteopaths will practice. In early 2002, a new Osteopathic Research Center opened at the University of North Texas Health Science Center in Fort Worth. The new Research Center is the result of collaboration among the American Colleges of Osteopathic Medicine, the American Osteopathic Foundation, and the American Osteopathic Association.

Many aspects of traditional osteopathic philosophy, such as advice about diet and smoking, have entered mainstream medicine to the point that the lines between DOs and MDs are blurring. In addition, the dedication of osteopaths to holistic medicine and primary care has been a great benefit to rural areas of the United States that are often underserved by mainstream practitioners.